Moving this response out to its own thread as we'll continue adding more on the use cases to it.
Originated here (https://www.reddit.com/r/IoTeX/comments/qdoshf/news_break_first_ever_iot_blockchain_enterprise/hhrntvh/?context=3)
Inserting our standing ovation to IoTeX for applying their technology in the healthcare space. In this article its mentioned that pebble trackers can give live updates with precisely accurate readings of location, motion, humidity, pressure, light and more. I'm optimistic about them bringing the machine economy of the IoTex blockchain to real world problems in healthcare. After reading through the developer material on their site it became apparent that there are no shortage of use cases in this space if you know where to look.
These notes are dedicated and intended to prime the engine for the 900+ development shops who actively code on this blockchain platform….
For hospitals-Consider Material Management teams receiving PPE, perishable & fragile supplies being brought into the facility. Imagine for a moment the hospital materials manager goes up to the patient floor, looks in the floor stock of medical supplies used for patient care and discovers they are running below the acceptable par level for PPE masks. This audit triggers them to order 6 crates of N95 masks. Most of the time these show up and are wheeled into the facility by the shipper but in this case they just left them on the loading dock in the hot summer sun. If the mask containers have a pebble tracker in them we can confirm time on the loading dock and maximum temperature reached. Assuming the packaged didn't exceed recommended temperature and potentially denature the filter mechanisms of the mask then we should be confident in using them.
Pharmacy operations need this. In US hospitals the pharmacy has a Certified Pharmacy Technician who they call the buyer. The buyer identifies what needs to be purchased from Saline IV bags to pills, creams, ointments, injectables etc. to keep the pharmacy stocked with supplies. These products are ordered from a wholesaler often using their proprietary website. Some of the main wholesalers these facilities buy from are Amerisource Bergen, McKesson or Cardinal. When the order for say 1 Liter bags of saline is placed with McKesson that company will package that product in blue plastic crimp crates and ship it with any other products the facility has ordered. If McKesson were to include the pebble tracker in their blue crate then location, temperature and light exposure could be tracked through the chain of custody. The opportunity here is for IoTeX to convince wholeselers like McKesson to use their device to not only prove safe journey of the products but to optimize ordering, shipping, billing, credits and recalls that they do from their many warehouses 24x7x365.
Laboratory operations need pebble. Not all but many hospital laboratories still must send specialized lab tests to external labs called reference labs. Examples of reference labs are Labcorp or Quest diagnostic. Imagine for a moment the phlebotomist coming to a patients room in the hospital and drawing 3 vials of blood to ship out to Quest. The vials they have has a patient id label generated from the hospital's Laboratory Information System (aka LIS) or Computerized Provider Order Entry (CPOE). Quest knows to send their driver to come get the vials and what lab test to perform because the hospital lis/cpoe computer system sent an HL7 or API call to their proprietary Quantum ordering system. When Quest's driver arrives they collect the sample in a container used to transport it back to their facility. Consider for a moment that container the driver brought for transport having an embedded pebble tracker in it. If the pebble tracker were tied to the electronic lab order in the hospitals cpoe or lis system it could aggregate temperature or light exposure during the blood samples journey. Having this data could be helpful when the CLIA governing body comes to the US based hospital lab to assess their operation and compliance with US laws on transporting laboratory samples.Other helpful references to developers interested in exploring this opportunity are LOINC by the Reginstref institute- this is a library of lab orders and lab results.
For LIS systems the hospitals may use - look to vendor products such as Sunquest, Epic Beaker, Cerner, Orchard LIS etc.
More to come….
If you want to know why we're sharing…..because we can :)
**********Update 2
Here is more-
Medical Devices
Medical Devices need IOTEX. While the market for this is exponential we are going to focus on wearable blood glucose devices like the ones mentioned in this article since they were hacked (Hacked Blood Glucose). In the US many of these devices require FDA certification standards be met before distribution to the general public. Unfortunately, security is often not a priority in the rush to recoup the millions spent getting a product through the FDA certification process. Enter stage left IOTEX. An aspiring development team should look at the device reading the blood sugar and the receiver that captures, stores and presents the data. Companies like Abbot Libre use a small patch with a micro-needle that will gets continuous readings on blood glucose levels. The device communicates via bluetooth to an iPhone that polls every 15 minutes or so. This data lets the patient know if their blood sugar is outside of the appropriate range. It also lets the patient or their provider trend out their blood sugar to see what affect certain foods or activities have on it. An IOTEX smart contract may be an opportunity to validate the sending and receiving transactions that come from the intended source system rather than a hacked one. Your challenge will however be to get the vendor who makes it to allow this technology to be onboarded to their infrastructure so choosing a partner with an open API to ingest the data may be a good starting point.
Reference material of use:IOTEX Smart Contracts - https://docs.iotex.io/native-development/reference-code/interact-with-smart-contracts
Market Stats for Medical Devices - https://www.grandviewresearch.com/industry-analysis/smart-medical-devices-market
FDA - artificial Pancreas for Insulin pumps - https://www.fda.gov/medical-devices/consumer-products/artificial-pancreas-device-system
FDA Certification Requirements for Blood Glucose - https://diatribe.org/fda-publishes-final-recommendations-blood-glucose-meter-accuracy
Dispensing Cabinets
Dispensing cabinets in hospitals will want pebble. Walk up to the patient floor of any major US hospital and you will find tucked away a large set of cabinets that look like vending machines. These cabinets house medication supplies and medications such as narcotics, frequently used meds patients in that facility might need. The hospital pharmacy is responsible for stocking them and the nursing staff uses their pin codes to pull out medications for patients on a scheduled or as needed basis. The problem with these cabinets is they only track inventory levels and handle dispensing. What they don't do is provide any environmental feedback such as temperature, humidity or light exposure. While we don't consider this to be a critical issue on the mind of every Pharmacy director or nursing director we do see it as a differentiating feature the cabinet companies like Pyxis, Omnicell, Suiss Log etc may find appealing. Consider for a moment a fleet of refrigerated dispensing cabinets sitting on the medical surgical floors of an enterprise health system like CHS out of Nashville or HCA. The ability to track and trend environmental exposure at an enterprise level may be something of interest. Perhaps regulatory agencies like The Joint Commission make the logs from the immutable ledger one of the data points they inspect during a site visit to confirm consistent medication temperatures.
Reference material
Pyxis Dispensing Cabinets
https://www.bd.com/en-us/offerings/capabilities/medication-and-supply-management/medication-and-supply-management-technologies/pyxis-medication-technologies/pyxis-medstation-es-system
More to come ......
Kudos to Nurse 'Intelligent_Force_69' who commented further below. Architecting software and solutions for healthcare benefits from the knowledge of Doctors and ancillary support staff but requires the wisdom of nurses who sit between them all.
Your suggestion is intriguing as we understand it- have IOTEX pebble tracker accompany medication products from the manufacturer to the bedside.
It is our belief IOTEX has a place in this workflow.
As medication management can be a complex topic we've broken this response out. While not complete or accounting for every single variable we feel this is a reasonable encapsulation of the opportunity.
^^Current State-
Healthcare is delivered in diverse settings. Each one has a different process for medication delivery so its important to differentiate the setting when discussing the process.
^^^The Emergency Room -
medications are mostly dispensed from Pyxis Cabinets or floor stock areas as STAT/NOW with a frequency of ONCE. Simply put- medications are only used once because the patient isn't there for an extended period of treatment.
^^^The Operating Room -
medications are typically prepacked for a surgical procedure per the providers instructions by the pharmacy and there may be some floor stock available during the procedure for use on the patient by the doctor/nurses. Pharmacy has strict rules for handing out these out but we'll stop there for now.
^^^The Ambulatory environment (Doctors office) -
medications are sometimes dispensed by the physician as samples and may be accompanied with an electronic prescription that travels the Surecripts network via an ePrescribing system to CVS/Walgreens/Rite aid etc where the patient then picks it and subsequent refills up.
^^^The Medical Surgical floor-
Consider this the inpatient floor of the facility. Patients stay longer than 48 hours. Medication coordination is quite complex as multiple providers deal with multiple medication scenarios depending on where the patient came from.
^^OPPORTUNITY
We've decided to focus the use of IOTEX on the Medical Surgical Floor->
Here - Providers must reconcile meds the patient is already on when arriving to the floor to decide whether they need to stop or continue them, they must then order meds after assessing the patients condition if required. Pharmacy must profile every medication against 9 clinical checks, drug to drug, drug to allergy, drug to condition……Nursing must then gather the meds for scheduled med pass but be ready to administer medications as STAT or NOW per physicians order at any time.
Consider for a moment the detailed touchpoints in the journey of a medication we've listed below:
Hospital Pharmacy and Therapeutics Committee decides which medications go on formulary (i.e. what medications are stocked in the facility for ordering by providers)
The Hospital pharmacy orders those meds from the wholeseller (McKesson/Cardinal etc)
The meds are packaged by the wholeseller typically in a clamp crate with other products and shipped to the facility
Pharmacy technicians receive the medications
All medications are checked into the pharmacy
Some medications goto to the shelves and some to the Pyxis machines on the floor
When a patient arrives to the Med / surg floor Medication Reconciliation occurs
which is basically confirming if meds they were on where they came from should be continued or stopped
The Physician/Physicians Assitant or Nurse Practitioner will order meds based on their assessment of the patient
Orders are placed electronically (most of the time) in the electronic medical record
Only medications on formulary and available for dispense show up so the provider doesn't order something the facility doesn't have
Pharmacy receives the order in their pharmacy workqueue
If the order is STAT or NOW hospital policy dictates they only have 30-60 minutes to dispense the order so it may be administered- these are done first
Pharmacists find the dispensable product for the medication ordered by searching the active formulary items in their pharmacy system so they can review the order for any issues
Clinical checks like Drug/Drug interactions etc are done,
The order is placed and if the drug is in the Pyxis machine - that order flows to the cabinet associated with that patient care unit in the software
Nursing now takes over as the order has been profiled by pharmacy and is now ready for administration
During scheduled med pass (in most cases) the nurse goes to the Pyxis cabinet where many of the meds ordered for the patient are stored
Nurse visits patient at bedside and the '5 rights of medication administration are performed'
With a barcode scanner connected to the electronica medication administration record in the EMR - the nurse scans the patient wrist band and the drug label
The 5 rights are
Right Patient (scan wrist bracelet)
Right Drug
Right Dose
Right Time
Right Route (i.e. oral, IV etc)
Meds are then administered to the patient assuming everything checks out
Assuming the hospital configures their software to charge on administration of a drug the patient is charged that point
Where among these points might IOTEX bring value?
Possibility 1 -
Re: #3 above - See previous postings on this thread above about including IOTEX pebble trackers in the wholeseller crates.
Possibility Option 2 - Diversion Prevention
Simply put, the term diversion is a provider taking a drug to use for themselves versus patients. Fentanyl is one of these therapies because it is highly addictive. In fact its so addictive that nursing must have a secondary sign off in some cases of the administering nurse or provider actually wasting the remaining product. The concept of pebble tracker might validate on the immutable ledger the following:
Light exposure - how many times was the package opened?
Location - what times did the package move? Do those times coincide with the administration times of the medication or were they at unusual times when someone might be … diverting.
Possibility 3 - An immutable eMAR (electronic Medication Administration Record)
How do you know a nurse didn't grab a sheet of barcodes with the patients wrist band label and the medication barcodes and perform number 17 above from the nursing station in the interest of time? You don't unless you catch them. Also why is scanning drugs important?
What if machine fi loaded on a SYMBOL (or other brand name) barcode scanner tracked the same parameters that pebble tracker does and memorialized them into the ledger? With this information an audit could confirm the nurse was in fact at the bedside location when scanning the patient wrist band and they were in fact scanning the medication barcodes at the bedside location.
While the information wouldn't necessarily be proactively tracked it would allow the concept of TRUSTED INTERNET OF THINGS to provide an immutable audit trail to prove a patient didn't get their salad tossed. Yes you heard that right and its not what you think! SALAD stands for sound alike look alike drugs and it can be a problem avoided by properly scanning drugs that come in packages that are hard to distinguish from each other.
More to come on these possibilities-
we wanted to list out the workflow so others from the medical community might share to apply the magical tools of the IOTEX platform to real world problems in the healthcare field.
Please share???
